Limosilactobacillus reuteri Strains as Adjuvants in the Management of Helicobacter pylori Infection.

Costantino Dargenio,Ruggiero Francavilla,Fernanda Cristofori,Vanessa Nadia Dargenio,Flavia Indrio,Francesca Bizzoco

doi:10.3390/medicina57070733

Abstract

Helicobacter pylori (HP) is a Gram-negative bacterium which finds its suitable habitat in the stomach. The infection affects about half of the global population with high variability in prevalence among regions and for age. HP is the main causative agent of chronic active gastritis, peptic and duodenal ulcers, and may be the primary cause of gastric cancer or MALT lymphoma. Due to the high rate of failure of eradication therapy in various countries and the increase in antibiotic resistance reported in the literature, there is an ever wider need to seek alternative therapeutic treatments. Probiotics seem to be a promising solution. In particular, the Limosilactobacillus reuteri (L. reuteri) species is a Gram-positive bacterium and is commonly found in the microbiota of mammals. L. reuteri is able to survive the gastric acid environment and bile and to colonize the gastric mucosa. This species is able to inhibit the growth of several pathogenic bacteria through different mechanisms, keeping the homeostasis of the microbiota. In particular, it is able to secrete reuterin and reutericycline, substances that exhibit antimicrobial properties, among other molecules. Through the secretion of these and the formation of the biofilm, it has been found to strongly inhibit the growth of HP and, at higher concentrations, to kill it. Moreover, it reduces the expression of HP virulence factors. In clinical trials, L. reuteri has been shown to decrease HP load when used as a single treatment, but has not achieved statistical significance in curing infected patients. As an adjuvant of standard regimens with antibiotics and pump inhibitors, L. reuteri can be used not only to improve cure rates, but especially to decrease gastrointestinal symptoms, which are a common cause of lack of compliance and interruption of therapy, leading to new antibiotic resistance.

Highlights

Helicobacter pylori (HP) is a Gram-negative flagellated spiraliform bacterium about 3 micrometers in size which finds its suitable habitat in an acidic environment
HP affects more than half of the world population, with a wide variability among different regions, going from 79.1% in Africa to 50% in Southern Europe in 2015, despite the fact that the prevalence of H. pylori has been rapidly declining for decades in some parts of the world [2]
Probiotics were given to 100 HP-positive naive patients during pre-eradication (28 days before antibiotics), eradication, and follow-up (8 weeks). We showed that this specific combination was able to significantly decrease HP bacterial load, significantly reduce antibioticrelated side effects (41% vs. 63%; p < 0.04), reduce serum gastrin-17 (28% vs. 12%; p < 0.02)

Summary

Introduction

Helicobacter pylori (HP) is a Gram-negative flagellated spiraliform bacterium about 3 micrometers in size which finds its suitable habitat in an acidic environment. The eradication rate was 60% in patients supplemented with L. reuteri, as compared to none in the group that received omeprazole plus placebo (p < 0.0001) [25].

Results

Conclusion